State Collection Service
Online Application for Employment

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of a non-job-related medical condition or handicap, or any other legally protected status. If you believe you have been discriminated against, you may notify the Federal Communication Commission, the Equal Employment Opportunity Commission or other state and/or local EEO agency.

We are an Equal Opportunity Employer
Red = Required Fields
Position applied for
Location
I have sent/will send my resume to you by e-mail.
I have sent/will send my resume to you by mail.
How did you learn about us?
PERSONAL INFORMATION

First Name
 Middle Name
 Last Name
 

Street Address

 
 

City

State

 

Zip Code

 

Home Phone
 Email Address
GENERAL INFORMATION

• If you are under 18 years of age, can you provide required proof of your eligibility to work? 
• Have you ever filed an application with us before? 
           If yes, give date
• Have you been employed with us before? 
           If yes, give dates, reason for leaving & name of last supervisor
• Are you currently employed? 
• May we contact your current and past employers? 
• Are you prevented from lawfully being employed in
this country because of VISA or Immigration Status? 
Proof of citizenship will be required upon employment.
• On what date would you be available to work? 
• Are you available to work? Full Time  Part Time  Shift Work  Temporary
• Are you currently on "lay-off" status and subject to recall? 
• Can you travel if a job requires it? 
• Have you been convicted of a felony or misdemeanor within the last 5 years? 
Conviction will not necessarily disqualify an applicant from employment.
           If yes, please explain.
• Do you speak any foreign languages? 
           If yes, which languages?
EDUCATION

High School
Name/Location
 Years Completed Diploma?

Undergraduate/College
Name/Location
 Years Completed Degree?
Describe Course of Study

Graduate/Professional
Name/Location
 Years Completed Degree?
Describe Course of Study
LIST PROFESSIONAL, TRADE, BUSINESS OR CIVIC ACTIVITIES OR OFFICES HELD
You may exclude memberships which would reveal sex, race, religion, national origin, age, ancestry, or handicap or other protected status.
Previous Employment
Give name, address and telephone number of previous emplyers
Employer 1
Name   From To
Address
Supervisor Phone
Reason for Leaving  
Employer 2
Name   From To
Address
Supervisor Phone
Reason for Leaving  
Employer 3
Name   From To
Address
Supervisor Phone
Reason for Leaving  
• Have you had any job-related training in the United States military?
           If yes, please describe
• Are you physically or otherwise unable to perform the duties of the job for which you are applying?


State Collection Service is an Equal Opportunity Employer